High rates of emotional distress and depressive symptoms in the community can reflect difficult life events and social circumstances. There is a need for appropriate, low-cost, non-medical interventions for many individuals. Befriending is an emotional support intervention commonly offered by the voluntary sector.

Aims

To examine the effectiveness of befriending in the treatment of emotional distress and depressive symptoms.

Method

Systematic review of randomised trials of interventions focused on providing emotional support to individuals in the community.

Results

Compared with usual care or no treatment, befriending had a modest but significant effect on depressive symptoms in the short term (standardised mean difference SMD=−0.27, 95% CI −0.48 to −0.06, nine studies) and long term (SMD = −0.18, 95% CI −0.32 to −0.05, five studies).

Conclusions

Befriending has a modest effect on depressive symptoms and emotional distress in varied patient groups. Further exploration of active ingredients, appropriate target populations and optimal methods of delivery is required.

46Compton, W, Conway, K, Stinson, F, Grant, B. Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991–1992 and 2001–2002. Am J Psychiatry2006; 163: 2141–7.

eLetters

Re: "Effects of Befriending on Depressive Symptoms: A Precautionary Note on Promising Findings"

Nicola Mead, Research fellow
16 June 2010

We should like to thank Dr El-Baalbaki and colleagues for their thoughtful comments on our recent paper. We agree with their cautious interpretation of the results of our meta-analysis.

We were interested in their suggestion that befriending serve as a comparator condition for more structured treatments such as collaborative care, to tease out the specific benefits of the latter over and above the general effects of increased attention and support, and to explore the cost-effectiveness of these complex organisational interventions. Althoughthis makes good sense in design terms, it does, however, relegate befriending to the status of comparator rather than active intervention. The recent Mental Health Foundation report 'The Lonely Society?'(1) highlights the impact of loneliness on health, and its findings are supported by the Royal College of Psychiatrists(2). We would therefore want to complement Dr El-Baalbaki and colleagues’ suggestion with further research specifically exploring the role of befriending as a potential alternative therapeutic intervention for certain groups, such as isolated older adults.

"Effects of Befriending on Depressive Symptoms: A Precautionary Note on Promising Findings"

Ghassan El-Baalbaki, Postdoctoral Fellow
02 June 2010

Mead et al. (1) recently meta-analyzed data on the effectiveness of befriending interventions on reducing depressive symptoms. Befriending wasdefined as a non-professional intervention that provides clients with non-directive, emotionally-focused support by one or more individuals; was notpsychoeducational or mentoring in nature; and did not constitute formal psychotherapy. Mead et al. found that befriending interventions had a modest, statistically significant effect on depressive symptoms within 12 months of randomization (standardized mean difference = 0.27, 95% CI =0.06 to 0.48, 9 studies) and a slightly smaller effect on longer-term outcomes (standardized mean difference = 0.18, 95% CI = 0.05 to 0.32, 5 studies).

As the authors noted, the effect sizes for befriending were essentially equivalent to effect sizes from collaborative care depression interventions in primary care. In a 2006 meta-analysis, Gilbody et al. (2)reported a short-term (within 6 months) standardized mean difference effect size for symptom reduction from collaborative or enhanced depression care of 0.25 (95% CI = 0.18 to 0.32, 35 studies) and longer- term effect sizes of 0.15 at 2 years post-randomization (95% CI = -0.03 to0.32, 9 studies) and 0.15 at 5 years post-randomization (95% CI = 0.001 to0.30, 2 studies). As Mead and colleagues note, the implications of this are important. Befriending or social support interventions could provide aless expensive and potentially ?less medicalized? option of care for patients with mild to moderate symptoms of depression in primary care. Indeed, collaborative care is a complex, multifaceted, expensive organizational intervention that can be difficult to implement outside of research settings (3, 4).

There are caveats, however. As noted by Mead et al., only a small setof heterogeneous studies have examined the effects of befriending interventions on depressive symptoms. Furthermore, as noted by Mead et al., funnel plot asymmetry suggested that publication bias may have influenced the estimate of the degree to which befriending may affect depressive symptoms. Mead et al. did not assess the degree to which publication bias may have influenced the results of the meta-analysis. However, if only studies with statistical power of at least 0.70 among thestudies with short-term outcomes evaluated by Mead et al. are analyzed, the resulting synthesized effect estimate is 0.08 (95% CI = -0.06 to 0.21,4 studies), a substantially smaller estimate than that produced by all 9 studies (0.27, 95% CI = 0.06 to 0.48). Thus, as noted by Mead et al., morehigh-quality research is needed on befriending in order to determine the likely benefit to patients in clinical practice.

Meanwhile, the results of the meta-analysis by Mead et al. suggest that future research on collaborative care should use a befriending or attention control group. Up to now, collaborative care interventions have been compared to usual care, and it is not known to what degree the effects that have been reported are due to specific effects of the collaborative care intervention versus effects that may come from the substantially increased attention and support received by patients in collaborative care.

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